HAVE YOU TAKEN THE NECESSARY HOURS FOR A RENEWAL OF YOUR EMERGENCY PERMIT?

YES

NO

IF CERTIFIED IN ANOTHER STATE, INDICATE WHICH ONE AND TYPE OF CERTIFICATE

(IT WILL BE THE RESPONSIBILITY OF THE APPLICANT TO SECURE A STATE TEACHING CERTIFICATE FROM THE STATE EDUCATION AGENCY)

LAST ELEMENTARY ATTENDEDTooltip

CITY, STATETooltip

DATES ATTENDEDTooltip

LAST HIGH SCHOOL ATTENDEDTooltip

CITY, STATETooltip

DATES ATTENDEDTooltip

DIPLOMA OR DEGREETooltip

COLLEGE OR UNIVERSITYTooltip

CITY, STATETooltip

DATES ATTENDEDTooltip

DIPLOMA OR DEGREETooltip

COLLEGE OR UNIVERSITYTooltip

CITY, STATETooltip

DATES ATTENDEDTooltip

DIPLOMA OR DEGREETooltip

TEACHING EXPERIENCE

YEARTooltip

NAME OF SCHOOL, CITY, STATETooltip

GRADES & SUBJECTS TAUGHTTooltip

NO. OF MONTHS EMPLOYEDTooltip

REASON FOR LEAVINGTooltip

YEARTooltip

NAME OF SCHOOL, CITY, STATETooltip

GRADES & SUBJECT TAUGHTTooltip

NO. OF MONTHS EMPLOYEDTooltip

REASON FOR LEAVINGTooltip

YEARTooltip

NAME OF SCHOOL, CITY, STATETooltip

GRADES & SUBJECTS TAUGHTTooltip

NO. OF MONTHS EMPLOYEDTooltip

REASON FOR LEAVINGTooltip

ARE YOU EMPLOYED IN A SCHOOL DISTRICT NOW?

YES

NO

IF YES, WHY DO YOU WISH TO CHANGE?Tooltip

WHY DO YOU WANT TO WORK IN THIS DISTRICT?

ADDITIONAL DATA

ARE YOU PHYSICALLY ABLE TO DO THE JOB FOR WHICH YOU ARE APPLYING?

YES

NO

HAVE YOU EVER BEEN TREATED FOR ANY MENTAL DISORDER?

YES

NO

HOW MUCH TIME HAVE YOU LOST FROM WORK DUE TO PERSONAL ILLNESS DURING THE LAST TWO YEARS?Tooltip

IS THERE ANY REASON THAT WILL PREVENT YOU FROM ACCEPTING ANY SCHOOL ASSIGNMENT OR ATTENDING MEETINGS OR OTHER SCHOOL ACTIVIITES HELD AFTER REGULAR SCHOOL HOURS?

YES

NO

IF YES, EXPLAIN.

ALL PERSONNEL OF THE SCHOOL DISTRICT, REGARDLESS OF CLASSIFICATION, ARE EMPLOYED, SUBJECT TO ASSIGNMENT, AND/OR REASSIGNMENT BY THE SUPERINTENDENT OR BY HIS OFFICIAL DESIGNATED REPRESENTATIVE BASED UPON THE NEEDS OF THE DISTRICT. DO YOU UNDERSTAND IF EMPLOYED YOU ARE SUBJECT TO REASSIGNMENT AS NEED ARISES?

YES

NO

THIS APPLICATION, IF PROPERLY COMPLETED, WILL BE KEPT ON FILE FOR TWO YEARS. IF THE APPLICANT IS NOT APPOINTED, AND HE/SHE WISHES FOR THE APPLICATION TO REMAIN CURRENT, THEN RENEWAL MUST BE MADE IN WRITING. IF REQUEST FOR RENEWAL IS NOT RECEIVED, THE APPLICATION WILL BE DESTROYED.

DO YOU HAVE A RELATIVE WHO IS A MEMBER OF THE BUNA BOARD OF EDUCATION?

YES

NO

DO YOU HAVE A RELATIVE WHO IS EMPLOYED IN ANY CAPACITY BUNA ISD?

YES

NO

NAME OF RELATIVETooltip

RELATIONSHIPTooltip

POSITION HELDTooltip

IF

Upload

IF

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REFERENCES (GIVE NAME OF SUPERINTENDENTS, PRINCIPALS, MAJOR PROFESSORS, SUPERVISORS OF STUDENT TEACHING, COOPERATING TEACHER, AND ANY OTHERS WHO HAVE OBSERVED AND KNOWN YOUR WORK AS A STUDENT OR TEACHER.) OUR OFFICE WILL WRITE FOR RECOMMENDATIONS.

NAMETooltip

TELEPHONE NUMBERTooltip

POSITIONTooltip

ADDRESS, CITY, STATE, ZIPTooltip

NAMETooltip

TELEPHONE NUMBERTooltip

POSITIONTooltip

ADDRESS, CITY, STATE, ZIPTooltip

NAMETooltip

TELEPHONE NUMBERTooltip

POSITIONTooltip

ADDRESS, CITY, STATE, ZIPTooltip

HAVE YOU EVER BEEN CONVICTED OF A FELONY OR OFFENSE INVOLVING MORAL TURPITUDE AND/OR RECEIVED PROBATION OR DEFERRED ADJUDICATION?

YES

NO

IF YES, PLEASE STATE WHERE, WHEN, AND THE NATURE OF THE OFFENSE:Tooltip

CONVICTION OF A FELONY IS NOT AN AUTOMATIC BAR TO EMPLOYMENT. THE DISTRICT WILL CONSIDER THE NATURE, DATE, AND RELATIONSHIP BETWEEN THE OFFENSE AND THE POSITION FOR WHICH YOU ARE APPLYING.

PLEASE STATE YOUR PERSONAL PHILOSOPHY OF EDUCATION AS IT RELATES TO YOUR FIELD OF PREPARATION.

DO YOU HAVE ANY ADDITIONAL INFORMATION YOU FEEL WILL HELP US MAKE A BETTER DECISION IN OUR CONSIDERATION OF YOU FOR A POSITION.